Provider Demographics
NPI:1578449849
Name:FEOLA, BRAILE S
Entity type:Individual
Prefix:
First Name:BRAILE
Middle Name:S
Last Name:FEOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1721
Mailing Address - Country:US
Mailing Address - Phone:510-940-5957
Mailing Address - Fax:
Practice Address - Street 1:268 LEWELLING BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:CA
Practice Address - Zip Code:94580-1632
Practice Address - Country:US
Practice Address - Phone:510-940-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health